3 years ago

Prognostic accuracy of cerebroplacental ratio and middle cerebral artery Doppler for adverse perinatal outcomes: a systematic review and meta-analysis

Ben Willem J. Mol, Christianne J. M. de Groot, Caroline J. Bax, Linda J. Schoonmade, Marjon A. de Boer, Charlotte A. Schreurs, Martijn W. Heymans, Patrick M. M. Bossuyt
Objective Ultrasonographic assessment of the cerebroplacental ratio (CPR) and middle cerebral artery (MCA) Doppler is widely used as an additional method to umbilical artery (UA) Doppler to identify fetuses at risk of adverse perinatal outcomes. However, reported estimates of its accuracy vary considerably. We conducted a systematic review with meta-analysis of studies on the prognostic accuracy of CPR and MCA Doppler, and compared this to UA Doppler. Methods We queried PubMed, EMBASE, the Cochrane Library, and ClinicalTrials.gov for studies on the prognostic accuracy of CPR or MCA Doppler for adverse perinatal outcomes in women with a singleton pregnancy of all risk profiles (from inception to June 2016). Risk of bias and concerns about applicability were assessed with the QUADAS-2 (Quality Assessment of Diagnostic Accuracy Studies-2) instrument. Meta-analysis was performed for multiple adverse perinatal outcomes. Hierarchal summary ROC curves were estimated. Prognostic accuracy of the tests was directly compared. Results We could include 128 studies (47,748 women). Risk of bias or suboptimal reporting was detected in 120/128 studies (94%) and substantial heterogeneity was found, which limited subgroup analyses for fetal growth and gestational age. Large variation was observed in reported sensitivities and specificities, and in used thresholds. CPR was significantly superior to UA Doppler in predicting composite adverse outcome (as defined in the included studies) (p < 0.001) and emergency delivery for fetal distress (p = 0.003), and comparable to UA Doppler for the other outcomes. MCA Doppler was significantly inferior to UA Doppler in predicting low Apgar score (p = 0.017) and emergency delivery for fetal distress (p = 0.034). CPR was significantly superior to MCA Doppler in predicting composite adverse outcome (p < 0.001) and emergency delivery for fetal distress (p = 0.013). Conclusion Calculating the CPR with MCA Doppler can add value to assessment of the UA Doppler by predicting adverse perinatal outcomes in women with a singleton pregnancy. However, in which population remains unclear. The effectiveness of CPR through guiding clinical management needs to be evaluated in clinical trials. Systematic Review Registration PROSPERO: International prospective register of systematic reviews; https://www.crd.york.ac.uk/PROSPERO/#index.php, CRD42016039915.

Publisher URL: http://onlinelibrary.wiley.com/resolve/doi

DOI: 10.1002/uog.18809

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